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Questions and Answers
What is the primary indication for performing thoracocentesis?
Which of the following is a complication that may arise from thoracocentesis?
What type of asthma is characterized by bronchial narrowing due to spasm of bronchial smooth muscles?
Which symptom often accompanies bronchial asthma attacks?
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What should be done urgently for a patient experiencing tension pneumothorax?
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What does eosinophilia in a blood picture suggest in the context of bronchial asthma?
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Which of the following investigations helps identify causative antigens in extrinsic asthma?
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What is considered the most severe form of bronchial asthma?
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What is the primary purpose of inhaled short-acting B2-agonists (SABA) in asthma management?
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Which of the following symptoms is NOT commonly associated with pneumonia?
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What type of pneumonia is commonly caused by Staphylococcus aureus?
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Which treatment is appropriate for Pneumocystis carinii pneumonia?
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Which finding would NOT be expected during auscultation in a patient with pneumonia?
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Which of the following is associated with Mycoplasma pneumonia?
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What is the main feature of Legionella pneumonia?
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Which medication is classified as a controller treatment for asthma?
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Study Notes
Pleural Diseases Treatment
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Thoracocentesis:
- Used primarily for pleural effusion.
- Involves needle insertion at the upper border of the rib below the scapular line, typically under the 10th rib.
- Must be performed under strict aseptic conditions.
- Potential complications include hemothorax, pneumothorax, neurogenic shock, and pulmonary edema.
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Intercostal Chest Tube (Under Water Seal):
- Indicated for pneumothorax (open, bilateral, or tension), empyema, and hemothorax.
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Tension Pneumothorax:
- Considered a medical emergency.
- Requires immediate insertion of a wide-bore needle in the 2nd intercostal space for decompression, followed by an intercostal chest tube.
- Supportive care includes oxygen and analgesics.
Bronchial Asthma
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Aetiology:
- Characterized by bronchial narrowing due to bronchospasm, inflammatory infiltrate (especially eosinophils), and mucus plugs.
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Pathophysiology:
- Can be classified into extrinsic (allergy-related) or intrinsic (bronchial hyper-reactivity) asthma.
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Clinical Picture:
- Patients are often symptom-free between attacks.
- Attacks typically occur at night or early morning, manifesting as wheezing, non-productive cough, and dyspnea.
- End of attack may produce small viscid sputum.
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Signs During Attack:
- Inspection reveals bilateral restricted respiratory movement.
- Palpable rhonchi and central trachea on palpation.
- Percussion shows bilateral hyper-resonance.
- Auscultation reveals harsh vesicular breathing with prolonged expiration and generalized rhonchi.
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Complications:
- Respiratory complications include status asthmaticus and respiratory failure.
- General complications can arise from treatments (e.g., steroids leading to diabetes mellitus, hypertension).
- Chronic cough complications include myositis, rib fractures, pneumothorax, hemoptysis, and extra-thoracic issues like puffy eyelids and hernias.
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Investigations:
- Sputum examination shows increased eosinophils.
- Eosinophilia observed in blood tests.
- Elevated serum IgE levels in extrinsic asthma.
- Skin prick tests identify causative antigens.
- Chest X-ray may show signs of hyperinflation.
- Pulmonary function tests indicate obstructive hypoventilation.
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Treatment:
- Short-acting B2-agonists (e.g., Salbutamol) serve as relievers.
- Inhaled corticosteroids (ICS) and long-acting B2-agonists (LABA) serve as controller medications.
- Oral leukotriene receptor antagonists (e.g., Montelukast) and oral or parenteral steroids (e.g., prednisolone) are also employed.
- IgE monoclonal antibodies (e.g., Omalizumab) may be useful for specific patients.
Pneumonia
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Clinical Picture:
- Common symptoms include fever, anorexia, headache, malaise, cough, dyspnea, and rusty sputum.
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Signs:
- Physical examination may reveal limited respiratory movements, increased tactile vocal fremitus on palpation, dullness on percussion, and bronchial breathing with crepitations on auscultation.
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Special Types of Pneumonia:
- Staphylococcal Pneumonia: Caused by Staphylococcus aureus; treated with nafcillin or vancomycin.
- Fridlander's Pneumonia: Caused by Klebsiella, especially in immunosuppressed patients; treated with ceftriaxone.
- Pneumocystis Jiroveci Pneumonia: Common in AIDS patients; treated with Septrin or pentamidine.
- Mycoplasma Pneumonia: Mostly affects children and young adults, can lead to systemic infections; treated with macrolides.
- Legionella Pneumonia: Caused by Legionella pneumophila from contaminated water; diagnosed by urine antigen test and treated with macrolides.
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Viral Pneumonia:
- Atypical pneumonia caused by various viruses, including influenza, CMV, EBV, RSV, measles, and coronaviruses like SARS.
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Description
This quiz covers key treatment methods for pleural diseases, focusing on thoracocentesis and intercostal chest tube procedures. It provides insights into indications, techniques, and potential complications. Test your knowledge on how to manage conditions like pleural effusion, pneumothorax, and hemothorax.
